Why You Need Regular Eye Exams

Your risk for eye-related disease increases as you age. Regular comprehensive eye exams can help protect your vision.

Roughly 11 million Americans older than 12-years old need vision correction, but glasses or contacts are just one reason to see an eye doctor. Comprehensive eye exams are essential for the early detection of health issues that can affect your vision.

As you age, your risk for diseases that can affect your sight, like glaucoma and macular degeneration, increases. During a comprehensive, dilated eye exam, doctors specializing in the eyes and vision, called ophthalmologists, or licensed health care professionals, known as optometrists, can not only pick up eye diseases that could lead to blindness or other complications, but also detect certain underlying health issues that can affect your eyes—even before you develop symptoms or realize that something is going on.

“Even though someone seems okay, sometimes there can be eye diseases that are manifesting themselves before the patient really has time to see them,” explains Corrie Weitzel, OD, MS, an optometrist at Cleveland Clinic’s Cole Eye Institute. “Routine eye exams are going to find those kinds of conditions and treat them before vision loss can set in.”

Americans aren’t getting their eyes checked
Despite the utility of eye exams, survey data suggests they’re underutilized. A 2016 Harris Poll, which was commissioned by the American Academy of Ophthalmology, found that 64 percent of U.S. adults reported having at least one vision problem, such as blurry vision, double vision, or difficulty seeing at night. Yet, only 13 percent of these people reported seeing an eye doctor about it.

The Centers for Disease Control and Prevention also reports that up to 45 percent of adults in the United States haven’t had a dilated eye exam within the last two years. And only about half of the estimated 61 million adults at high risk for vision loss visited an eye doctor during the past year. (Keep in mind, there are free or low-cost options available, particularly for older people and those at higher risk for eye diseases.)

What happens during an eye exam
A comprehensive eye exam will include:

  • Dilation: You will receive eye drops that widen your pupil, allowing more light to enter your eye. (This is why you will be sensitive to light for a few hours after your appointment.) Once your pupils have been widened, your eye doctor will have a better view of what’s going on in the back of your eye.
  • Tonometry: This test is used to measure the pressure inside your eye. It can detect glaucoma.
  • Vision tests: These tests will assess your visual acuity (sharpness), peripheral (side) vision and depth perception as well as your eye alignment and movement.

Why regular eye exams are essential
Some eye problems don’t cause any symptoms while others may develop gradually. In fact, their progression may be so slow that you may not even notice the problem until it has become severe.

Regular eye exams are your best bet for finding eye diseases and eye-related issues before they threaten your vision or your health.

One of the most common reasons most of us end up getting a comprehensive eye exam (as a kid or as an adult) is because we’re having trouble seeing things far away (myopia, or nearsightedness), or close up (hyperopia, or farsightedness).

As people get older, they could also develop presbyopia, or age-related loss of the ability to focus at close range. Astigmatism, which is an irregularity in the curvature of the cornea or lens, could also affect the sharpness of your vision. If you wear contacts or eyeglasses, your eye doctor will likely recommend that you come in regularly to have your prescription checked, Weitzel says.

Some of the other, less common, but potentially serious eye problems your provider might diagnose during a routine comprehensive exam include:

  • Amblyopia: Also called “lazy eye,” amblyopia is one of the most common eye-related problems among children. It can develop when there is a problem with the brain-eye connection (strabismus), causing one eye to be weaker than the other so they do not work together properly. If detected early on, these issues can be addressed and treated, reducing the risk for changes in vision.
  • Eye (ocular) melanoma: Eye melanomas, which are relatively rare, can develop in the cells in your eye that produce pigment. Most eye melanomas don’t cause early symptoms and aren’t visible to the naked eye.
  • Choroidal nevi (choroidal freckles): These are relatively common noncancerous lesions that develop in the back of the eye. They don’t usually require treatment unless they become cancerous or there is an increased risk for melanoma.
  • Age-related macular degeneration: As the name implies, this problem is typically linked to aging and occurs when either abnormal blood vessels grow behind the retina and cause blood and fluid to leak, or when the macula (the most sensitive part of the retina) thins over time. It’s a leading cause of permanent vision loss in older adults.
  • Open-angle glaucoma: This is the most common form of glaucoma, accounting for at least 90 percent of all cases. It results from gradual clogging of the eye’s drainage canals, which increases pressure inside the eye. In cases of open-angle glaucoma however, the angle where the iris meets the cornea is as wide as it should be. There may not be any noticeable vision loss until the disease has progressed to an advanced state, making routine eye exams critical for early detection.   
  • Cataract: If not treated, this clouding of the eye lens can lead to blindness. Cataracts can develop at any age or be present at birth, but they are more common in older adults.  Cataracts are treated with a routine surgical procedure.

Other health conditions that may be detected
Certain underlying health issues can affect your eyes and your vision. Even before you develop symptoms, an eye doctor can detect subtle change in your eyes, such as swelling of the optic nerve, bleeding or floating white blood cells within the eye, that enable these conditions to be diagnosed early on before they’ve progressed. This can not only ensure you receive the treatment you need, but also help protect your vision.

“There are many times where people come in for a routine eye exam and we look inside and see signs of a systemic disease, which would make them want to follow up with their primary care doctors,” Weitzel says.

Some of the underlying health issues that could be detected during a comprehensive eye exam include:

  • Diabetes: Over time, high blood sugar levels can damage the blood vessels in the retina. This condition, called diabetic retinopathy, is a leading cause of blindness among U.S. adults.
  • Anemia: If you are iron deficient, the skin inside your eyelids may look pale.
  • High blood pressure: This condition can damage the vessels supplying blood to the retina. It can lead to bleeding in the eye, blurry vision or fluid buildup under the retina.
  • Multiple sclerosis (MS): This disease can lead to inflammation of the optic nerve or damage to the nerves involved in eye movements. This can lead to a dark spot in the field of vision, blurred or grayed vision, or blindness in one eye.
  • Rheumatoid arthritis (RA): This chronic inflammatory disease could lead to dry eyes. RA can also cause inflammation in the white part of the eyes, causing redness and pain.
  • Lupus: This auto-immune disease can affect the eyes, leading to changes in the skin around the eyelids, dry eyes, inflammation of the white part of the eyes, blood vessel changes in the retina, and damage to the nerves involved in eye movement.
  • IBD (irritable bowel disease): Roughly 10 percent of those with IBD experience eye problems. In most cases, these issues, which can lead to symptoms like irritation, sensitivity to light or redness, are treatable.

When to have your eyes examined
How often you need an eye exam depends on certain factors, including your age and other risk factors for eye-related health issues. Be sure to talk to your eye doctor, or your primary care doctor about what is right for your situation.

There is no doubt that regular comprehensive eye exams are important, Weitzel says, but how “regular” they should be is a complicated answer.

The American Academy of Ophthalmology recommends that adults younger than 40-years old with no signs of risk factors for eyes disease get a comprehensive exam every 5 to 10 years. Those between 41 and 54-years old, should have an exam every 2 to 4 years, and people between 55 and 64-years old should have one every 1 to 3 years. By the age of 65, adults should get a comprehensive eye exam once per year or every other year.

Those at higher risk for glaucoma and other eye diseases, such as African Americans and Hispanics, may need more frequent screenings. Those younger than 40-years old, may need to have an exam every 2 to 4 years, and continue to be screened every 1 to 3 years until the age of 54 and every 1 to 2 years until age 64—even if they don’t have any symptoms.

If you have risk factors for conditions that can affect your eyes or your vision, such as high blood pressure or diabetes, you may also need to have your eyes examined more often. For example, people with type 1 diabetes should be examined by an ophthalmologist five years after they’re diagnosed and have a repeat exam every year. Those with type 2 diabetes should have their eyes examined at least once per year after being diagnosed.

Eye symptoms you shouldn’t ignore
Don’t wait until your next scheduled comprehensive eye exam, and seek medical attention right away if you develop any sudden change in your vision or experience any of the following, which could signal a serious health issue:

  • Vision loss or double vision
  • Eye pain, burning or stinging
  • Painful red, swollen or itchy eyes
  • Green or yellow discharge from the eyes
  • New or more floaters (tiny black dots or specks that appear to float before your eyes)
  • Circles (halos) around lights
  • Flashes of light
  • Unequal pupils (one pupil is larger than the other)
  • Eye trauma
  • Eye exposure to chemicals
  • Bruising around the eye

Medically reviewed in March 2019.

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